Erick Munoz wants to see his wife's wish fulfilled this holiday season, but it's one that carries ethical and legal challenges: To be taken off of life support. Marlise Munoz, 33, is in serious condition in the intensive care unit at John Peter Smith Hospital in Fort Worth, Texas, hospital officials said.

She is unconscious and on a ventilator, her husband told CNN affiliate WFAA, but she wouldn't have wanted her life sustained by a machine.
"We talked about it. We're both paramedics," he told WFAA. "We've seen things out in the field. We both knew that we both didn't want to be on life support."

Complicating an already difficult situation is that Munoz is also pregnant, about 18 weeks along, WFAA reported. Texas state law prohibits withdrawing or withholding life-sustaining treatment from a pregnant patient, regardless of her wishes.

Patients can indicate their future wishes about medical treatment, in the event that they are unable to communicate them, through forms called advance directives. But in Texas, under the Health and Safety Code, such a form includes the provision "I understand that under Texas law this Directive has no effect if I have been diagnosed as pregnant."

Erick Munoz told WFAA doctors said his wife may have suffered a pulmonary embolism, which happens when blood clots travel to the lungs from elsewhere in the body. They do not know how long the baby went without nutrients and oxygen.

The hospital would not release specific details about Marlise Munoz's condition, but officials said the hospital would follow Texas law regarding care during pregnancy.

"We have a responsibility as a good corporate citizen here in Tarrant County to also provide the highest quality care we can for all of our patients," said J.R. Labbe, vice president of communications and community affairs for JPS Health Network, in a statement.

"But at all times, we will follow the law as it is applicable to health care in the state of Texas. And state law here says you cannot withhold or withdraw life sustaining treatment for a pregnant patient. It's that clear."

The husband and wife, both paramedics in the Tarrant County area, have a 14-month-old son named Mateo.

Erick Munoz and Marlise Munoz's mother did not immediately respond to requests for comment from CNN.

Erick Munoz found his wife unconscious on November 26, around 2 a.m. He performed CPR on her and then called 911, WFAA reported.

Since that day, the pregnant woman has been on life support, her husband said. Tests have shown that the fetus has a normal heart beat, he said. At 24 weeks, doctors may know more about when the fetus can be taken out, Munoz's family told WFAA. Doctors have also discussed the possibility of taking the fetus to full term.

He told WFAA that his wife had said she would not want to be kept alive by machine, and said he has reached "the point where you wish that your wife's body would stop."

Munoz wears his wife's pink and blue bracelets on his wrist, WFAA reported. Her wedding ring is on his pinkie.

When Munoz walks in the door, he said his son Mateo is waiting for his mother to show up.

Totally understand but the problem is they don't know the health of the baby\fetus.

As far as I'm concerned, on all questions, you err on the side of life. I don't even comprehend how this is a question. It doesn't compute to me that anyone could find a virtuous path from "we don't know if the health of the baby" to "we should just let it die - it's the right thing to do."

I don't really know how I would argue this case because in a situation this traumatic one doesn't know how they would react until they are in the shoes of the person.

My initial thought is that I know my wife would want to do everything she could to save the baby, and if that meant using her body as a resource, I know that is what she would want....so I would probably do everything I could to honor that.

I say that as someone in our circle is losing a young child today. You just don't know what you would do.

I don't really know how I would argue this case because in a situation this traumatic one doesn't know how they would react until they are in the shoes of the person.

My initial thought is that I know my wife would want to do everything she could to save the baby, and if that meant using her body as a resource, I know that is what she would want....so I would probably do everything I could to honor that.

I say that as someone in our circle is losing a young child today. You just don't know what you would do.

Will be an interesting case study afterwards when looked at through the new prism of ObamaCare and what will be paid for/not paid, allowed/not allowed. One would have to assume at this point the mother and baby would be best off under the care of a Catholic Hospital not constrained by HHS rules

Why do you think there are HHS rules that would have any effect on what medical care this woman would receive in Texas if she were at a Catholic hospital or not and what would be covered by insurance or not?

As far as I'm concerned, on all questions, you err on the side of life. I don't even comprehend how this is a question. It doesn't compute to me that anyone could find a virtuous path from "we don't know if the health of the baby" to "we should just let it die - it's the right thing to do."

Like I said to shrink, not everyone believes like you do. I would probably wait it out since it is only a short amount of time to find out if the baby is healthy but if my wife was 2-3 weeks pregnant, I might choose different

Quote:

When 'life support' is really 'death support'

Two young females, both brain dead without warning, remain on ventilators while their devastated families challenge the judgments of their hospitals. In one situation, the family believes a miracle is possible, and wants to prolong the patient's biological functioning. In the other case, the family wants to disconnect the patient to honor her wishes. But both families are facing obstacles.

The way we talk about neurological death has created a misperception, ethicists say: that "brain death" is somehow not as final as cardiac death, even though, by definition, it is.

The term "life support" exacerbates the problem, too, because those who are brain dead do not have a life to sustain, said Arthur Caplan, director of the Division of Medical Ethics at NYU Langone Medical Center. This seems to be a fundamental problem in both cases that have entered the national spotlight, he said.

"I think these cases have been botched, horribly," he said. "They're giving the impression that dead people can come back to life."

Brain dead, but kept alive

Here's a quick overview of the two situations:

Doctors in Oakland, California, declared Jahi McMath, 13, to be brain dead on December 12, three days after she underwent surgery to remove her tonsils, adenoids and extra sinus tissue, which doctors thought were causing sleep apnea.

She suffered complications from the procedure, which experts have told CNN is commonly done, but not routine.

A judge concluded Tuesday that Jahi is brain dead, but ruled that Jahi will remain on life support at least until December 30. The family of the teen is seeking to move her to another facility for treatment, the girl's uncle, Omari Sealy, told reporters Thursday.

Moving her would require the insertion of tracheostomy and gastrostomy tubes, family attorney Christopher Dolan said.

However, hospital Chief of Pediatrics David Durand said the judge didn't authorize a transfer to another facility.

"Children's Hospital Oakland does not believe that performing surgical procedures on the body of a deceased person is an appropriate medical practice. Children's Hospital Oakland continues to extend its wishes for peace and closure to Jahi McMath's family," Durand said.

But Jahi's mother, Nailah Winkfield, said on Friday, "I would probably need for my child's heart to stop to show me that she was dead. Her heart is still beating, so there's still life there."

In Texas, a hospital and family of a brain dead patient also clash over continuing life support, but the situation is further complicated because the woman is pregnant.

Marlise Munoz, 33, has been unresponsive since November 26, when her husband, Erick Munoz, discovered her on the kitchen floor at their home, said her mother, Lynne Machado. The family says she is being kept alive on a ventilator at John Peter Smith Hospital in Fort Worth, Texas.

Her family says she would not want her life prolonged by a machine, but Texas state law says "life-sustaining treatment" cannot be withheld from a pregnant patient, regardless of her wishes or the age of the fetus.

"At all times, we will follow the law as it is applicable to health care in the state of Texas," said J.R. Labbe, vice president of communications and community affairs for JPS Health Network, which oversees the hospital.

Life and death

These cases may make you think of Terri Schiavo, a brain-damaged woman who died in 2005 after living on a feeding tube for more than a decade. Schiavo was the subject of a lengthy legal battle between her parents and her husband, Michael Schiavo, who maintained she wouldn't have wanted to live in a "persistent vegetative state."

Both these situations are distinct from brain death -- according to the Uniform Determination of Death Act, an individual is dead when he or she "has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem."

"It seems like there seems to continue to be confusion about what it means to die using neurologic criteria," said Cynda Hylton Rushton, professor of clinical ethics at Johns Hopkins University.

Rushton suggests, in fact, that this phrase "die using neurological criteria" be used instead of "brain death," to emphasize what it means.

Terms such as "mechanical support" or "artificial machine support" could be used to refer to sustaining the functioning of a brain dead person, Caplan said.

"No one wants to take away 'life support,' " Caplan said.

Unpacking the issues

In Caplan's view, it doesn't do any families any good if hospitals ask them about mechanically continuing biological function in a brain dead patient.

He says doctors should be more transparent about the finality of brain death.

"It just creates the possibility of a terrible scenario like the one that's unfolded (in Jahi's case), where the parents don't really understand and then start to resist any removal of machines because they just want to hope that the worst possible thing did not happen," he said. "I don't think it's kind to not be clear when death happens."

In the Texas case, Caplan noted, where it's the family against a law, if Munoz is indeed brain dead, she is not, by definition, receiving "life-sustaining treatment."

It seems to Caplan that the law's intention was not to continue treating the dead.

"That the heart can continue breathing in a body like this is unnerving to people," said Kenneth Goodman, director of the Bioethics Program at the University of Miami.

One might argue that the fetus is alive, and is the one on "life support." But that opens up a lot of other issues: Will the fetus be viable? Was it damaged by the mother's lack of oxygen when she lost consciousness? Right now it is 18 weeks old; Machado said doctors will know more about its health at 22 to 24 weeks.

The Texas law in this case "imposes the view of the state on the adult pregnant woman, as to whether or not the fetus counts as a human being," Peter Singer, professor of bioethics at Princeton University, said.

Starting new dialogues

The misunderstanding surrounding cases such as Jahi's and Munoz's signals a need for a national conversation about brain death and levels of brain functioning, Caplan said.

Although there are scientific criteria for "brain death," the concept contains a moral judgment, Singer said. When viewed in connection to organ transplantation, there seems to be a value assessment that, for instance, the organs of a brain-dead person should be used to save someone else's life.

Organ transplantation and the idea of brain death have different origins, researchers argue in a 2007 paper in the Journal of Medical Ethics, but they became linked in 1963, when the first kidney transplant with a brain dead donor was performed.

Had these procedures with brain dead patients not emerged until more recent decades, in a cultural climate rife with right-to-life debates, perhaps there would have been more public discussion and controversy about the definition of "brain death," Singer said.

The public might have taken a closer look at what matters: Is it the "person," which exists by virtue of a functioning brain, or the organism?
"If you think that somehow what is precious, or what has a right to life, is simply an organism, then I suppose you might say, 'Well, this is not dead,'" he said. "This organism is still able to function. It needs medical support, but of course there's a lot of people who need medical support."

Jahi's family has said they are hoping for a miracle. Such cases also bring up the question of what is society's responsibility to accommodate requests based on faith, Rushton said.

"We really need to engage in a new dialogue that takes us out of the debate of faith into science, into a conversation about what are the limits of our human knowledge and technology, and how do we accept the fact that all of us will eventually die?" Rushton said. "These are the kinds of situations where there are no easy answers."

Medicine can't cure everything, but we act as though death is optional, she said.

We may have technology called "life support," but even that can't last forever.

Why do you think there are HHS rules that would have any effect on what medical care this woman would receive in Texas if she were at a Catholic hospital or not and what would be covered by insurance or not?

Catholic hospitals have been standing up against Government mandated rules that go against the beliefs of the church. I would assume that in this case the Catholic hospital would err on the side of the baby and would see it through to birth. A non Church related hospital will likely be required to do the bidding of HHS and government that has proven has no regard for life before birth and would err on the side of economy and kill two birds with one stone so to speak.

These are the benefits of a Godless government health care system. However let us not mention death panels.

__________________
Frazod to KC Nitwit..."Hey, I saw a picture of some dumpy bitch with a horrible ****tarded giant back tattoo and couldn't help but think of you." Simple, Pure, Perfect. 7/31/2013

Dave Lane: "I have donated more money to people in my life as an atheist that most churches ever will."

Fort Worth, Texas (CNN) -- A Texas judge ordered a Fort Worth hospital to remove a pregnant and brain-dead woman from respirators and ventilators on Friday, perhaps ending a wrenching legal debate about who is alive, who is dead and how the presence of a fetus changes the equation.

Erick Munoz, husband of Marlise Munoz, broke down in tears after Judge R.H. Wallace told John Peter Smith Hospital to act on his order by 5 p.m. Monday.

Munoz and other family members had been fighting to have the body released for burial. Hospital officials resisted, saying they were trying to obey a Texas law that says "you cannot withhold or withdraw life-sustaining treatment for a pregnant patient," in the words of the hospital spokesman.

Munoz left the courthouse without talking to reporters, but the family's lawyers spoke out. Jessica Janicek argued that the hospital was "utilizing (Marlise Munoz's) body as a science experiment."

A breakthrough came when the hospital and the Munoz family agreed on crucial facts listed in a court document: that Marlise Munoz, 33, has "met the clinical criteria for brain death since November 28" and that "the fetus gestating inside Mrs. Munoz is not viable."

The woman's husband repeatedly made these claims in his efforts to have her removed from the machines.

The story may have more chapters. The hospital could appeal or decide to remove Marlise Munoz from a ventilator and respirator before that deadline. The judge did not rule on the constitutionality of a state law regarding the treatment of a pregnant patient.

Erick and Marlise Munoz, two trained paramedics, had been awaiting the arrival of their second child when she was found unconscious on her kitchen floor around 2 a.m. November 26. She was rushed to the north-central Texas hospital.

Once there, Erick Munoz said, he was told his wife "was for all purposes brain dead." The family also says the fetus may have been deprived of oxygen. Erick Munoz had contended doctors told him his wife "had lost all activity in her brain stem" and an accompanying chart stated that she was "brain dead."

During Friday's hearing in Fort Worth, representatives of the hospital -- in this case, from the Tarrant County District Attorney's office -- argued that state law was correctly applied.

Erik Munoz and other family members said the hospital should abide by her wishes -- which weren't written down but, they said, relayed verbally to them -- and not have machines keep her organs and blood running.

In an affidavit filed Thursday in court, Erick Munoz said little to him now is recognizable about Marlise. Her bones crack when her stiff limbs move. Her usual scent has been replaced by the "smell of death." And her once lively eyes have become "soulless."

After the Friday hearing, another family lawyer, Jessica King, said, "Pregnant women die every day. They die in car accidents, of heart attacks and other injuries. And when they die, their fetus dies with them.

"It's the way it's always been and the way it should be."

In his lawsuit, Munoz claims subsequent measures taken at the hospital -- and, in turn, the state law used to justify them -- amounted "to nothing more than the cruel and obscene mutilation of a deceased body against the expressed will of the deceased and her family."

The hospital and the Tarrant County District Attorney's Office, which defended the medical facility, did not offer the same level of detail as members of the Munoz family.

But earlier this month, hospital spokesman J.R. Labbe told CNN that his hospital believed "the courts are the appropriate venue to provide clarity, direction and resolution in this matter."

Late Friday, the hospital issued this statement: "JPS Health Network appreciates the potential impact of the consequences of the order on all parties involved and will be consulting with the Tarrant County District Attorney's office."